Moving target: Albuterol decreases in latest ASP figures

Sunday, September 23, 2007

WASHINGTON - The neb-med industry took the latest average sales price figures in stride last week. Reimbursement for albuterol and Xopenex slid 26 cents to $1.05--a quicker drop than expected for some, not such a surprise to others.

"There were no big shockers," said Sam Jarczynski, president of RxStat in St. Petersburg, Fla. "Albuterol had the biggest drop, but it's not enough to affect the market."

On July 1, CMS began paying the same for brand-name Xopenex as for albuterol (Q4094), resulting in a sharp decrease in the amount of Xopenex that providers dispense.

Mickey Letson, president of Decatur, Ala.-based Letco Companies, estimated his Xopenex sales have dropped 60% to 65% since July 1, and he predicts it will drop another 20% before leveling off.

"We'll see a point where providers will have changed all the patients that doctors will allow to be changed," said Letson. "(For those patients), whether you make money or lose it, you've got to provide it."

Industry watchers describe the reimbursement for albuterol as a moving target. With fewer providers dispensing Xopenex, the weighted average for the two drugs will decrease, leading to lower ASP figures over the next few quarters, eroding profitability for providers.

Tom Ryan, CEO of Homecare Concepts in Farmingdale, N.Y., said it's getting harder to dispense Xopenex.

"We try not to take any new cases," he said. "In the cases where doctors won't prescribe generics, it's a loss, but we look at that in the bigger realm of things, and we will work with patients, especially those with oxygen."

The still-favorable albuterol pricing has also led to some providers dispensing less DuoNeb--essentially albuterol and ipratropium in a single vial. The new reimbursement for DuoNeb is $1.08. That spells bad news for patients who will have to mix their own medications, which reduces compliance, said Jarczynski.

Other ASP figures barely changed: Ipratropium dropped a penny to 17 cents per unit dose and budesonide increased 6 cents to $4.80.